Flashcards in Exam 4 addiction/drug abuse Deck (75):
____ ___: Changes that have occurred in the body after repeated use of a drug that necessitates the continued administration of a drug to prevent a withdrawal syndrome
Physical dependence - NOT an addiction
_____ are usually physically dependent on the drug they are abusing
Addicts - pt's who use opiates for chronic pain management are likely to be physically dependent
____ ____: perceived need or craving for a drug
Psychologic dependence - often feel they cannot function without continued use of that substance
Physical dependence disappears within ___ or ___ after drug use stops, but psychological dependence can last ___ ___.
days or weeks
Psychological dependence is primarily reason for ____
_____: With repeated dosing, the dose of the drug must be increased to produce the same effect or with consecutive dosing, the same dose of the drug produces less of an effect and need a higher dose to produce the desired effect
_____ ____ produce "central" tolerance (function or behavioral)
Psychoactive drugs - definite decrease in the response of brain tissue to constantly increasing amounts of the drug
Central tolerance is NOT the same as ____ ____ which is caused by an accelerated rate of metabolism of the drug
metabolic tolerance - insignificant factor in tolerance observed in humans to most psychoactive drugs
Withdrawal syndrome can range from mildly unpleasant to life threatening, it is dependent on what 5 factors?
1. drug used
2. dose and route of administration
3. concurrent use of other drugs
4. frequency and duration of drug use
5. Genetics of user (age, sex, health)
Addiction: _____ ___ ___ behavior where acquiring and using a drug becomes the most important activity in the user's life. Loss of ___ regarding drug use. Continued use despite serious ____ and or ____ consequences. With addiction there is always ____ ____.
Compulsive drug seeking
7 Behavioral signs of addiction
1. preoccupation with obtaining the drug
2. compulsive use in spite of adverse consequences
3. relapse following periods of abstinence
4. anal retentive
5. obsessive compulsive
____: physiological tolerance to or psychological dependence on a drug, short of addiction
____: The behavior of others who are associated with the drug addict that results in continued drug abuse
Enabling - inappropriate coping mechanism by the enabler that negatively reinforces the addicts behavior
The state of being free of drugs
Abstinence - goal of drug tx programs
____: when drugs are used in a manner or amount inconsistent with medical or social patterns of a culture
Abuse - non sanctioned used of controlled substances/use of legal pharmaceuticals outside of the scope of sound medical practive
Drugs are abused to alter what 4 things?
4. action of CNS - alleviate pain, anxiety, depression, induce sleep, energize
4 factors that increase potential for abuse
2. quick/rapid onset
4. easy to obtain/distribute
Treatment - individual must have the desire to stop for best chance of success, what 3 other things are included in tx?
1. counseling for behavioral change
3. self-help groups
Why are drugs absorbed more quickly and more easily in kids vs adults?
Increased membrane permeability
Typically children receive ___ of the adult dose
___ of a drug differs from abuse - implies that the drug is being used inappropriately for the patients disease state. Using the wrong drug for the wrong problem, or the wrong dose for a longer period than prescribed
A primary, chronic, progressive, relapsing disease process with genetic, psychosocial and environmental factors influencing its development and manifestations
What is the usual progression of addiction?
experimental -> social use -> abuse -> addiction
(Gateway drugs = alcohol/nicotine)
In a dental office, what 3 things should be avoided in a patient that has a history of drug abuse
Opiates, benzodiazepines, and NO2
When comparing drugs in the same group, the time required to produce physical dependence is ____ with a rapidly metabolized drug and ____ with a slowly metabolized drug
primary reason for relapse
What are 3 cardio side effects of inhalants? What is the chemical that causes these?
1. Increases sensitivity to epi -> can lead to sudden death
2. irregular heartbeat
3. MI risks
IV injection of opioid drugs often results in what 4 things?
1. Hep B
2. HIV infection
4. Damaged heart valves ( IV drug users require antibiotics premed prior to receiving and dental tx)
2 drugs used to tx narcotic/opiate overdose
1. naloxone (Narcan) (acute)
2. methadone (long-term rehabilitation)
7 signs of opiate overdose
1. fixed pinpoint pupils
2. depressed respiration
5. slow/absent reflexes
antidote to BDZ overdose
flumazenil "blocker drug"
Will not block CNS effects from alcohol, barbiturates, general anes. or opiates
What will flumazenil not reverse?
respiratory depression/hypoventilation it also may cause seizures
Alcohol is eliminated by ___ ___ kinetics. A constant amount of alcohol is metabolized and eliminated per unit of time regardless how much alcohol has been ingested ___ g per hour. Excreted in ___ and ___.
lungs and urine
7 oral complications of alcoholism
2. loss of tongue papillae
3. angular cheilitis
4. fungal infections
5. bleeding (liver damage)
6. oral cancer (squamous cell)
7. leukoplakia/ulceration of lateral borders of tongue
Alcoholism in older adults considerations include: _____ body water and lean body ____ making alcohol more concentrated. Decline in ____ and ____ function. _____/weightloss. More injuries/falls. _____ alcohol more slowly therefore stays in body ____. May develop biological ____ disorder, _____ health problems, and _____ problems like depression, anxiety, isolation, and _____.
liver and kidney
6 signs/symptoms of biological brain disorder
1. simple withdrawal
2. delirium tremens
4. organic hallucinations
4 drugs what interact with alcohol
1. aspirin/NSAIDS = GI bleeding
2. acetaminophen = liver damage
3. cold/allergy/antihistamines = drowsiness/impaired judgment/coordination
4. CNS drugs = sleepiness/poor coordination/dyspnea/tachycardia/memory problems
8 signs of chronic alcohol use
6. peripheral neuropathy
7. amnesic syndrome
Alcohol withdrawal occurs in stages, what are 8 of the symptoms
1. psychomotor agitation
2. ANS hyperactivity
4. paranoid behavior/delusions
7. grand mal seizures
8. delirium tremens
7 treatments for alcohol withdrawal
1. ventilation suppoprt
3. vit B6
5. sodium bicarb
7. disulfiram (Antabuse)
how does disulfiram (Antabuse) work?
inhibits metabolism of aldehyde dehydrogenase which increases the serum levels of acetaldehyde. When taken with alcohol, you vomit, thirst/palpitations/vertigo/headache - deters person from wanting to drink
Symptoms of overdose with CNS stimulant
1. dilated pupils
3. elevated pulse
4. cardiac arrhythmias
5. extreme sweating
6. hyperthermia (leads to brain damage/seizures/death)
7. hyperactive behavior
what is a therapeutic use of amphetamine?
Treats ADHS, narcolepsy, and short term for obesity
What are 4 desired effects of nicotine
1. increased alertness
2. muscle relaxation
3. facilitation of concentration and memory
4. decreased appetitie
9 harmful effects of nicotine
3. camel face
4. increased HR
5. induces nausea/vomiting
8. lung cancer
9. oral cancer
8 withdrawal symptoms of nicotine
3. difficulty concentrating
6. increased appetite
7. sleep disturbances
8. craving tobacco
People often require _____ quit attempts before they are finally successful
4 examples of hallucinogens
1. diethylamine (LSD)
2. phencyclidine (PCP)
3. mescaline (peyote)
3 problems with long term use of hallucinogens
2. panic disorders
Hallucinogens have ___ medical uses, they alter all ___ ___, cause perceived heightened ____ where ____ are brighter/clearer, ____ are more brilliant, and taste/smell/touch are more ____. Psychological _____ and _____ develops quickly.
Hallucinogens are powerful CNS stimulants and can have what 4 effects
1. adverse CNS effects
Hallucinogens are _____ and will have adverse cardio effects with mixed with ____.
2 main chemical of the 500 chemicals in marijuana
1. delta-9-tetrahydrocannabinnol (THC)
2. cannabidiol (CBD)
8 effects of THC
2. muscle relazation
3. appetite stimulation
5. mood alterations
8. anticholinergic (at high dose)
6 effects of CBD
2. muscle relaxant
6. decrease psychotic effects of THC
10 uses of medical marijuana
7. glaucoma (reduces intraocular pressure)
9. sleep apnea
10. Tourettes syndrome
4 adverse short term effects of mj
1. problems with memory/learning
2. distorted perception
3. difficulty in thinking/problem solving
4. loss of coordination
6 Problems with long term use of mj
1. physical dependence
3. psychological dependence
5. increased risk for depression
6. increased risk for and earlier onset of schizophrenia
7 signs/symptoms a person is high on weed
1. increased HR
2. blood shot eyes
3. slow to respond
4. slurred speech
5. glazed eyes
6. order on breath or clothes
4 oral complications of mj
4. hyper keratinized tissues
2 complications of chronic mj use
1. chronic bronchitis
2. precancerous changes in bronchioles
K2/spice causes similar effects to mj, what is it made of?
herbal mixture, incense/potpourri
dronabional (Marinol) = what?
Is a schedule 3 drug and it is approved for what 2 things?
synthetic version of THC
1. subsides nausea and vomiting from chemo
2. appetite stimulate in AIDS patients
A term used to identify drugs that can be used to facilitate sexual assault
Name 3 predatory drugs
rohnpnol is an benzo not approved for use in the US, aka?
What happends when rohypnol is mixed with alcohol?
by itself causes: muscle relaxation, amnesia, and seadative
GHB is a CNS depressants aka?
sodium oxybate (Xyrem) - analogue to GHB found in industrial solvents/cleaners not defected in tox screen
3 effects of GHB
what may happen when GHB is taken with meth?
3 adverse side effects of GHB
2. difficulty breathing
4 withdrawal effects of GHB
3 effects of ketamine
1. sedative hypnosis
how is ketamine different from PCP?
more rapid onset and less potent